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ABSTRACT: We evaluated the results of extravesical ureteral reimplantation in children.
We reviewed the records of 128 children (174 ureters) who underwent ureteral reimplantation via extravesical techniques. Primary vesicoureteral reflux was the most common diagnosis (73 patients).
The extravesical technique produced a successful result in all patients (no reflux or obstruction). The 2 complications included postoperative urosepsis and transient urinary retention.
Extravesical ureteral reimplantation is a reliable procedure with predictable results comparable to those of more traditional intravesical techniques.
The Journal of Urology 06/1996; 155(5):1721-2. · 3.75 Impact Factor
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Urology 01/1996; 46(6):888-98. · 2.43 Impact Factor
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K A Burbige
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ABSTRACT: To assess the effect of simplified postoperative management of hypospadias repair in an outpatient setting.
The records of 162 boys were reviewed who underwent hypospadias repair by the following techniques: meatal-based flap (72), free skin graft (54), two-stage repair (21), and bladder mucosal graft (15). Urinary diversion was provided by open catheter drainage in the latter three groups, and a simple wrap penile dressing was used in all patients. With the exception of the bladder mucosal graft technique, all procedures were performed as outpatients.
Complications requiring a second surgical procedure occurred in 28 patients (17%). No patient required rehospitalization during the postoperative period.
These results compare favorably to previously reported series utilizing traditional postoperative techniques.
Urology 06/1994; 43(5):719-21. · 2.43 Impact Factor
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K A Burbige
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ABSTRACT: A case is reported of massive adrenal hemorrhage in a newborn with evidence of bleeding in utero. A large cystic mass noted on prenatal ultrasonography at 20 weeks of gestation was followed by serial examinations until birth at 38 weeks of gestation. Postnatal evaluation included abdominal sonography, diethylenetriaminepentaacetic acid renal scan, voiding cystourethrography and abdominal plain film. Surgical exploration confirmed massive adrenal hemorrhage.
The Journal of Urology 01/1994; 150(6):1867-9. · 3.75 Impact Factor
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ABSTRACT: Between 1977 and 1991, 14 patients were treated for genitourinary sarcoma (mean age, 7.4 years). The primary site was bladder in six patients, prostate in five, and vagina in three. Histological study showed embryonal rhabdomyosarcoma in 12 and leiomyosarcoma in 2 children. Initial therapy included biopsy followed by chemotherapy in all patients. Subsequently, five patients had anterior exenteration, four underwent partial cystectomy, and one patient had a radical prostatectomy; four patients were treated with chemotherapy and external beam pelvic irradiation (4,000 to 6,000 rads) alone. Overall survival for the group is 100% (follow-up 6 to 168 months). Two of four patients undergoing partial cystectomy had bladder augmentation at the time of surgery. All patients having partial cystectomy had negative surgical margins, are tumor free, and have volitional voiding. Two of four patients (50%) initially treated with chemotherapy and radiotherapy alone have had significant bladder deterioration requiring bladder reconstruction. There has been an evolution toward less radical, initial surgical intervention in pediatric genitourinary sarcoma; however, surgical resection continues to be the primary curative modality. Partial cystectomy with or without primary reconstruction may be preferable to exenteration for selected patients. Primary reconstruction at the time of partial cystectomy leaves a functional bladder and excellent long-term results. Children treated with chemotherapy and radiotherapy protocols alone must be monitored for late bladder deterioration.
Journal of Pediatric Surgery 09/1993; 28(8):1019-22. · 1.45 Impact Factor
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ABSTRACT: A total of 63 prepubertal and 17 pubertal males were examined to determine both testicular volumes and to correlate testicular volumes with the presence or absence of a varicocele. In the prepubertal group neither the left nor the right testicle predominated in size. In the pubertal group, the left testicle with an associated varicocele was smaller than the right.
Urology 06/1993; 41(5):466-8. · 2.43 Impact Factor
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K A Burbige
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ABSTRACT: A combined transpubic-perineal 1-stage approach was used for urethral replacement and proximal urethral repair in 6 boys: 4 were treated for a long proximal urethral stricture secondary to trauma and 2 with urethral atresia underwent replacement of the entire anterior urethra. All patients underwent a urethral substitution graft of either skin or bladder mucosa. Followup ranged from 2 to 8 years with all patients continent.
The Journal of Urology 11/1992; 148(4):1235-8. · 3.75 Impact Factor
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K A Burbige
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ABSTRACT: A review of 120 children who underwent ureteral reimplantation by the cross-trigonal or Politano-Leadbetter technique is presented. Over-all success rates (no postoperative reflux or ureteral obstruction) were 96.7% for the Politano-Leadbetter method and 97.8% for the cross-trigonal technique. There were no failures using either method in patients operated upon for primary vesicoureteral reflux.
The Journal of Urology 12/1991; 146(5):1352-3. · 3.75 Impact Factor
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ABSTRACT: Salt losing nephropathy, occurring predominantly in male infants, has been reported in association with a spectrum of urologic diseases including obstructive uropathy and massive, infected vesicoureteral reflux (VUR). This has been called pseudo-hypoaldosteronism (PHA) or alternatively, pseudo salt-losing congenital adrenal hyperplasia (CAH), and is thought to reflect a tubular unresponsiveness to aldosterone. We report our experience with six cases, discuss one case in detail and review the 39 cases previously reported. A one month old male infant presented with a left upper quadrant mass. Signs and symptoms included vomiting, dehydration, hyponatremia and hyperkalemia. This suggested the diagnosis of CAH for which therapy was instituted. Ultrasonographic examination subsequently revealed the mass to be a urinoma in an infant with posterior urethral valve (PUV) and obstructive hydronephrosis.
Pediatric Radiology 02/1991; 21(6):413-5. · 1.67 Impact Factor
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ABSTRACT: Posterior urethral valves are known to be associated with considerable morbidity and mortality especially in the neonate. Recently the role of bladder dysfunction in the pathophysiology of renal function impairment and urinary incontinence after valve ablation has been questioned. From 1976 to 1986 we treated 50 male newborns with posterior urethral valves at our institution. Initial treatment in all cases consisted of bladder drainage by a urethral catheter, and correction of existing fluid and electrolyte abnormalities. Subsequent treatment was dictated by the degree of upper tract abnormalities and it included valve ablation alone in 24 patients, vesicostomy and later valve ablation in 8, valve ablation and later upper tract reconstruction in 14 and cutaneous ureterostomy in 4. Followup ranges from 2 to 12 years (mean 6.8). Long-term renal functional impairment was related to the serum creatinine at age 1 year. If the serum creatinine was below 1.0 mg.% all patients (31) had normal values at long-term followup and if it was greater than 1.0 mg.% (19) then only 7 patients had normal values at followup. Urinary continence was assessed in 42 patients and it was normal in 34 (81%). The etiology of incontinence in the remaining 8 patients was bladder dysfunction in 6 and sphincter incompetence in 2. Those patients with urinary incontinence also had a high incidence of upper tract abnormalities (6 of 8, 75%) compared to continent valve patients (10 of 34, 29%).
The Journal of Urology 12/1990; 144(5):1209-11. · 3.75 Impact Factor
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ABSTRACT: Flow cytometric analysis was performed on the testicular aspirates of 45 consecutive children with unilateral cryptorchidism undergoing elective orchiopexy or orchiectomy. Concomitant histological analysis was performed on the testicular tissue obtained from either biopsy or orchiectomy specimens. In all cases deoxyribonucleic acid histograms appeared to correspond with microscopic appearance. Histograms from prepubescent patients demonstrated 85 to 95% of cells in the diploid (2c) peak and less than 10% of cells in the tetraploid peak (4c), representing prepubertal testes without active spermatogenesis. Three distinct patterns of ploidy were identified in postpubertal children corresponding to the histological appearances of normal spermatogenesis, maturation arrest and the Sertoli-cell-only syndrome, respectively. In addition, we identified an aneuploid cell population in the specimen from 1 patient, suggesting that this testis may be at risk for future malignant degeneration. We conclude that flow cytometry of testicular aspirates is an easy and effective means of testicular evaluation, which may permit predictions regarding the fertility and malignant potential of undescended testes in postpubertal children.
The Journal of Urology 09/1990; 144(2 Pt 2):494-8; discussion 512-3. · 3.75 Impact Factor
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ABSTRACT: We review 24 children and young adults who underwent continent urinary diversion. The indications for an operation included bladder exstrophy in 11 patients, myelomeningocele in 8, sacral agenesis in 3, cloacal anomaly in 1, and traumatic disruption of the bladder neck and urethra in 1. The operations performed included an Indiana pouch in 19 patients, including 12 whose stoma was brought to a perineal position and 7 whose stoma was placed in the anterior abdominal wall. A Kock pouch was used in 2 patients and the Mitrofanoff principle was used in 3. The particular indications for the different procedures are discussed at length. Postoperative daytime continence as defined by at least 4 hours of dryness is present in all 24 patients to date, while 4 have nocturnal incontinence. Renal function is stable in all patients to date. In 18 patients postoperative urine cultures were positive during followup. All patients are on clean intermittent catheterization and reoperation has been required in 2 relating to an inability to perform postoperative intermittent catheterization. Two patients underwent reoperation for small bowel obstruction. The series supports the use of continent urinary diversion as a viable alternative to traditional forms of conduit diversion in children and young adults.
The Journal of Urology 06/1990; 143(5):981-3. · 3.75 Impact Factor
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ABSTRACT: Between 1945 and 1985 a total of 207 patients (male-to-female ratio 2:1) was treated at our institution for exstrophy of the bladder. Primary anatomical bladder closure was performed in 137 patients, of whom 42 (31 per cent) eventually required urinary diversion. Primary urinary diversion was the initial treatment in 70 patients, including ureterosigmoidostomy in 40, ileal conduit in 17, colon conduit in 11 and cutaneous ureterostomy in 2. Secondary urinary diversion was necessary in 35 patients and included continent diversion in 7. Primary anatomical bladder closure, done within 72 hours of birth and followed by staged reconstruction of the bladder neck, was the most successful surgical regimen for the treatment of bladder exstrophy. Acceptable urinary continence was achieved in 82 per cent of our patients with this approach. However, multiple procedures often were required to achieve continence.
The Journal of Urology 10/1989; 142(3):793-5; discussion 795-6. · 3.75 Impact Factor
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ABSTRACT: The in utero leakage of meconium from the gastrointestinal tract into the peritoneal cavity results in the clinical entity known as meconium peritonitis. A patent processus vaginalis in the male fetus may lead to the migration of meconium into the scrotum, and these infants can present with soft meconium-filled hydroceles at birth. Local tissue reaction during the first several weeks of life results in calcification of these hydroceles into hard tumor-like lesions that may mimic testicular neoplasia. We report an atypical case of meconium hydrocele in a newborn.
The Journal of Urology 06/1989; 141(5):1172-3. · 3.75 Impact Factor
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ABSTRACT: Between 1945 and 1985, 207 patients were treated at our institution for exstrophy of the urinary bladder. Primary anatomical bladder closure was performed in 137 patients. In 97 patients treated prior to 1975, bladder closure was performed at a median age of 1 year and continence in this group was only 16%. Forty patients treated after 1975 underwent closure at a median age of 72 hours followed by staged reconstruction of the bladder neck. Continence in this group was 82%; however, the average number of surgical procedures was five as compared with two in the first group. Early bladder closure and staged reconstruction can achieve acceptable urinary continence, but multiple surgical procedures may be required.
Journal of Pediatric Surgery 01/1989; 23(12):1102-6. · 1.45 Impact Factor
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ABSTRACT: Between 1970 and 1985, 10 male newborns with a contained urinoma were treated at our institution. An underlying congenital obstructive uropathic condition was discovered in every patient, the most common of which was posterior urethral valves. All 10 patients underwent surgical correction of the primary obstructive process. Direct drainage of the urinoma was required in 4 patients because of progressive clinical symptoms. Radiographic and renal functional parameters returned to normal at followup. Clinical presentation, evaluation, treatment and pathophysiology of this rare entity are discussed.
The Journal of Urology 12/1988; 140(5 Pt 2):1319-22. · 3.75 Impact Factor
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ABSTRACT: Nine patients 15 to 28 years old underwent placement of the artificial urinary sphincter around an internal intestinal urinary reservoir. A total of 15 complications was experienced in 8 patients and 13 secondary procedures were necessary. Eight patients are completely continent and 1 has nighttime enuresis. The most common complication encountered was reduction in bowel luminal circumference underlying the sphincter cuff.
The Journal of Urology 11/1987; 138(4 Pt 2):1123-5. · 3.75 Impact Factor
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ABSTRACT: We reviewed our experience with the diagnosis and management of varicoceles in 40 patients 9 to 18 years old. Of the patients 29 underwent varicocelectomy and 11 are being managed conservatively with periodic followup. The results of therapy and criteria for surgical intervention are discussed.
The Journal of Urology 11/1987; 138(4 Pt 2):1038-40. · 3.75 Impact Factor
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ABSTRACT: Vascular lesions of the scrotum though most often varicoceles, can occasionally represent either benign or malignant tumors containing vascular elements. Two pediatric patients presenting with vascular scrotal masses resembling varicoceles are reported. Histologic interpretation of the operative specimens demonstrated benign tumors of the scrotum. Hemangiomas, hamartomas, or mesenchymal tumors should be especially suspect in the presence of any vascular right scrotal lesion. Because of the infrequency of prepubertal varicoceles, any vascular lesion of the scrotum in this age group should undergo biopsy before simple excision is performed to rule out the presence of malignancy. Early excision of benign mesenchymal tumors is especially important if, as some believe, they eventually dedifferentiate to more malignant tumors later in the lifetime of an individual.
Urology 07/1987; 29(6):612-5. · 2.43 Impact Factor
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ABSTRACT: Among our 56 patients who have undergone urinary tract reconstruction with intact bladders 45 have required some compensation for lost ureteral length. Of these patients 33 had only distal ureteral loss and underwent reconstruction with a combination of a psoas hitch, transureteroureterostomy and primary reimplantation. Four patients with more extensive ureteral loss underwent a Boari flap procedure, and of the 8 patients with major ureteral loss 6 had small bowel interposition and 2 have had renal autotransplantation to compensate for lost ureteral length. All patients are well with stable renal function at 1 to 7-year followup.
The Journal of Urology 05/1987; 137(4):707-11. · 3.75 Impact Factor
